Hui Lin Ong

Prevalence of frailty and its association with sociodemographic and clinical characteristics, and resource utilization in a population of Singaporean older adults.

The present study examined the prevalence of frailty and its association with sociodemographic, clinical and social characteristics, and service utilization in a representative general population sample of Singaporean older adults.

Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care

BACKGROUND Metabolic syndrome (MetS) and cardiovascular risk are highly prevalent among individuals with schizophrenia. This study aimed to determine the cardiometabolic profile and the associated risk factors in a group of institutionalized patients with schizophrenia or schizoaffective disorder receiving prolonged hospital care in the only tertiary psychiatric institution in Singapore. METHODS Patients residing in long stay wards who were hospitalized for a minimum period of 1year were recruited. Fasting blood sample was collected to obtain levels of blood glucose, total cholesterol, high-density lipoprotein (HDL) and triglycerides. Waist circumference, blood pressure, height and weight were also measured. The prevalence of MetS and the 10-year cardiovascular risk were determined. RESULTS This inpatient group had a mean age of 56.1years and an average length of hospitalization of 8.8years. The prevalence of MetS in this group was 51.9% and 26.9% based on the AHA/NHLBI and modified NCEP ATP III criteria respectively. Those in the high risk BMI category and those who had pre-existing diabetes had higher odds of MetS. Their 10-year cardiovascular risk was estimated at 12.8%, indicating intermediate risk based on the Framingham risk function. CONCLUSION Despite the low smoking rate in this group of inpatients, their cardiovascular risk appeared to be relatively high possibly due to old age and age-related conditions such as hypertension and low HDL. While literature has found the use of atypical antipsychotic medications to increase the risk of MetS, we did not find any significant association. Additionally, the duration of hospitalization did not affect the rate of MetS in our sample.

Performance of Mini-Mental State Examination (MMSE) in long-stay patients with schizophrenia or schizoaffective disorders in a psychiatric institute.

Studies have found that age and education were associated with cognition in older adults. However, little is known how clinical factors (e.g. age of illness onset, length of hospital stay, type of antipsychotic medications, and duration of illness) are associated with cognitive functioning in patients with schizophrenia. This study aimed to examine the influence of socio-demographic and clinical factors on cognitive domains measured using Mini-Mental State Examination (MMSE) among patients with schizophrenia or schizoaffective disorders residing in a psychiatric institute in Singapore. A single-phase interview was conducted at the Institute of Mental Health (IMH) in patients diagnosed with schizophrenia or schizoaffective disorders (n=110). MMSE was administered to all participants. Data on socio-demographic characteristics, smoking, alcohol consumption, and medical history were collected. Age, gender, and level of education were significantly associated with MMSE scores. After adjusting for all socio-demographic correlates, longer length of hospital stay remained significant in predicting lower MMSE scores. Length of hospital stay was independently associated with cognitive functioning. Early interventions for cognition such as physical and mental exercises should be implemented for better prognosis.

Correct recognition and continuum belief of mental disorders in a nursing student population

BackgroundThe current study aimed to explore the correct recognition of mental disorders across dementia, alcohol abuse, obsessive compulsive disorder (OCD), schizophrenia and depression, along with its correlates in a nursing student population. The belief in a continuum of symptoms from mental health to mental illness and its relationship with the non-identification of mental illness was also explored.MethodsFive hundred students from four nursing institutions in Singapore participated in this cross-sectional online study. Respondents were randomly assigned to a vignette describing one of the five mental disorders before being asked to identify what the person in the vignette is suffering from. Continuum belief was assessed by rating their agreeableness with the following statement: “Sometimes we all behave like X. It is just a question of how severe or obvious this condition is”.ResultsOCD had the highest correct recognition rate (86%), followed by depression (85%), dementia (77%), alcohol abuse (58%) and schizophrenia (46%). For continuum belief, the percentage of respondents who endorsed symptom continuity were 70% for depression, 61% for OCD, 58% for alcohol abuse, 56% for dementia and 46% for schizophrenia. Of concern, we found stronger continuum belief to be associated with the non-identification of mental illness after controlling for covariates.ConclusionsThere is a need to improve mental health literacy among nursing students. Almost a quarter of the respondents identified excessive alcohol drinking as depression, even though there was no indication of any mood symptom in the vignette on alcohol abuse. Further education and training in schizophrenia may need to be conducted. Healthcare trainees should also be made aware on the possible influence of belief in symptom continuity on one’s tendency to under-attribute mental health symptoms as a mental illness.

Positive Caregiving Characteristics as a Mediator of Caregiving Burden and Satisfaction With Life in Caregivers of Older Adults

Background: Satisfaction with life is recognized to be a factor in alleviating burden in stressful caregiving duties. However, the mechanism underlying this relationship is indistinct. Positive aspects of caregiving (PAC) may help to regulate caregiving burden among caregivers of older adults. The study aims to examine whether positive caregiving characteristics mediate the effect between satisfaction with life and burden of care. Methods: Participants were 285 caregivers of older adults (aged 60 and above) in Singapore and were recruited in a cross-sectional, self-report study (mean [M] = 47.0 years; 64.6% females). Measures included in the study were the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), and the Satisfaction with Life Scale (SWLS). Mediation analyses were used to study the indirect effects of life satisfaction on caregiver burden through features of PAC. Results: Mean scores for the ZBI, PAC, and SWLS scales were M = 23.15 (standard deviation [SD] = 15.98), M = 34.55 (SD = 8.19), and M = 23.56 (SD = 6.62) respectively. Results from the mediation analysis revealed that the association between life satisfaction and caregiving burden was significantly mediated by the PAC (P < .001). Discussion: Positive aspects of caregiving may be a mechanism that links satisfaction with life and caregiver burden. Findings may represent attempts to manage caregiving duties as well as maintaining a positive attitude toward their responsibilities.

Pathways to care among psychiatric outpatients in a tertiary mental health institution in Singapore

Background: Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services. Aim: The current study aimed to explore the associations of patients’ socio-demographic characteristics with pathways to first contact and duration of untreated mental illness. Method: A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations. Results: Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own. Conclusion: Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.

Psychiatry as a career choice among medical students: a cross-sectional study examining school-related and non-school factors

Objectives Given the low recruitment to psychiatry worldwide, the current study aimed to examine how premedical and intramedical school factors, perception of career aspects, attitudes towards psychiatry, stigma towards mental illness and personality traits may affect the likelihood of psychiatry as a career choice. Design Cross-sectional online study. Participants 502 medical students from two public medical institutions in Singapore. Methods We critically examined existing literature for factors identified to influence psychiatry as a career choice and explored their effects in a group of medical students in Singapore. To avoid overloading the regression model, this analysis only included variables shown to have significant association (p<0.05) with the outcome variable from the initial Χ2 test and independent t-test analyses. Results A considerable number of non-medical school factors such as preschool influence and interest, personality traits and importance of a high status specialty in medicine were found to affect students’ choice of psychiatry as a career. Among medical school factors, attending a psychiatry/mental health club was the only influential factor. Negative attitudes towards psychiatry, but not stigma towards people with mental illness, significantly predicted the likelihood of not choosing psychiatry as a career. Conclusions Improving educational environment or teaching practice in psychiatric training may aid in future recruitment for psychiatrists. While the changing of premedical school influences or personality factors may be infeasible, medical schools and psychiatry institutes could play a more critical role by enhancing enrichment activities or clerkship experience to bring about a more positive attitudinal change towards psychiatry among students who did consider a career in psychiatry.

Head circumference, leg length and its association with dementia among older adult population in Singapore

Head circumference and leg length serve as reliable proxy indicators of early‐life environment. Research studies have shown that these anthropometric measurements are associated with cognitive impairment and dementia among older adults. The aim of the present study was to assess the associations between dementia with head circumference and leg length among the older adult population in Singapore. This study also aimed to examine the sociodemographic correlates of these anthropometric measurements.

Stigma towards mental illness among medical and nursing students in Singapore: a cross-sectional study

Objectives To assess stigma towards people with mental illness among Singapore medical and nursing students using the Opening Minds Stigma Scale for Health Care Providers (OMS-HC), and to examine the relationship of students’ stigmatising attitudes with sociodemographic and education factors. Design and setting Cross-sectional study conducted in Singapore Participants The study was conducted among 1002 healthcare (502 medical and 500 nursing) students during April to September 2016. Students had to be Singapore citizens or permanent residents and enrolled in public educational institutions to be included in the study. The mean (SD) age of the participants was 21.3 (3.3) years, with the majority being females (71.1%). 75.2% of the participants were Chinese, 14.1% were Malays, and 10.7% were either Indians or of other ethnicity. Methods Factor analysis was conducted to validate the OMS-HC scale in the study sample and to examine its factor structure. Descriptive statistics and multivariate linear regression were used to examine sociodemographic and education correlates. Results Factor analysis revealed a three-factor structure with 14 items. The factors were labelled as attitudes towards help-seeking and people with mental illness, social distance and disclosure. Multivariable linear regression analysis showed that medical students were found to be associated with lower total OMS-HC scores (P<0.05), less negative attitudes (P<0.001) and greater disclosure (P<0.05) than nursing students. Students who had a monthly household income of below S

Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study

4000 had more unfavourable attitudes than those with an income of SGD